Hole Ousia is beyond measurement.
Lennox and Gotthelf, in “Philosophical Issues in Aristotle’s Biology”:
Hans-Georg Gadamer, in “The Enigma of Health” :
In a poetic form by Peter J. Gordon:
Hole Ousia
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Tag Archives: medical humanities
Not fitting the pattern
This is a post about the mental health debate held at the Scottish Parliament on Tuesday 6th January 2015. Alexander McCall Smith wrote to me recently recommending this book (appreciating that I had graduated in Landscape Architecture):
My recent posts have, as a result, been based on patterns. 
This is the pattern of my Tuesday in Edinburgh. It is however not just a recent pattern but an old one too:
Waverley: I arrived in the toon of my birth 200 years since Walter Scott wrote his novel.
At the station, this was one of several Walter Scott quotes that I noticed: 
But before the parliamentary debate, I had arranged to meet a dear friend: 
My friend “dares to know” like no other I know. 
We met for a bowl of soup at the storytelling centre on the Royal Mile. Here I was lucky to meet my friend’s son. Who I found to be a very fine young man. 
The following quote was displayed at the storytelling centre: 
The soup was good. The company and shared stories even better. 
Our conversation over soup reminded me of Aesculapius. Edinburgh doctors, of enlightenment days, formed the “Aesculapian club”.
I need no “club”: I need only soup and good company.
On the way to the parliament we passed by the Poetry library.
This statue of Robert Fergusson lies opposite to the poetry vennel. 
This was Fergusson’s 18th century view of medical language,’authority’ and learning. 
Just before entering Scotland’s parliament one is met by the poetry wall. 
The Scottish parliament is a most wonderful building. Rich in pattern and in materials.
It has no simple pattern.
The Presiding Officer started proceedings [given her confusion, thank goodness there was no “routine” cognitive screening as mandated by Healthcare Improvement Scotland!] 
The Minister for Sport, Health Improvement and Mental Health, Jamie Hepburn, MSP, led off the debate on mental health: 
The debate began. 18 MSPs in a mostly empty parliamentary chamber.
My mind turned to a visit to the parliament five years before with my daughter’s primary school class. That was a day of lots of lively minds.
Jamie Hepburn’s address was followed by much parliamentary comment about stigma. 
Stigma is a subject that I have written about and made films. My understanding is that stigma is experienced by the person. It is not a simply entity. 
I read all the time. 
My reading reminds me of how little I know. 
I share C. P. Snow’s concern. As a graduate in both Arts and Sciences I have experienced very different cultures. I am not sure how healthy such separation is.
As a critical mind I sometimes feel alone. However I do feel reassured that I seem to be on the same page as Kenneth Calman and Sir Harry Burns. 
I agree with Kenneth Calman. Though I would insist that experience also matters. 
We are perhaps taught from an early age to appreciate arts and sciences as entirely separate. 
History is also taught in separation. 
The “pattern” that I am attempting to present has strayed from the parliamentary debate. 
Dr Richard Simpson, in his reply to the Cabinet Minister, outlined his concern about the “divide” between body and mind. 
The above was written by John Logie Baird in his diary at the time that he demonstrated television. ![CropperCapture[1]](https://holeousia.files.wordpress.com/2015/01/croppercapture11.jpg)
I welcomed Dr Simpson’s speech:
Dr Simpson is aware of my view that I feel that informed consent to cognitive assessment is important [the above written by an elderly patient recently] . Dr Simpson said to parliament:![CropperCapture[2]](https://holeousia.files.wordpress.com/2015/01/croppercapture2.jpg)
My concern here is that our elders will find that they have no choice in such assessments. I am interested in ethics. For me this means listening to experience. ![CropperCapture[4]](https://holeousia.files.wordpress.com/2015/01/croppercapture4.jpg)
The above was part of the contribution by John Mason, MSP, to the mental health debate. A contribution that I welcomed.
Whilst I do worry about “target” dominated healthcare, the following findings did concern me: ![CropperCapture[5]](https://holeousia.files.wordpress.com/2015/01/croppercapture5.jpg)
Over regulation is a worry for me. We may find a day when professionalism is out-weighted by regulation.
Below is an imbalance that I find concerning. Is this the real basis of loss of parity?My closing thought on the mental health debate: I am of the view that Scotland, in its approach to mental wellbeing, needs to embrace a more pluralistic outlook: an outlook that includes those with lived experience, critical minds and the medical humanities.
END [with a young doctor] and “patients who don’t quite fit the patterns”
An Interview
For the first time in 13 years I attended a job interview. I had feedback after my interview which indicated that the panel had felt I was “too personal” in my manner and that the panel had wanted me to be more emphatic: to give crystallised answers to the complex questions asked.
It occurs to me that the two areas of feedback I received return to the use of language. This is an aspect of self.
I am proud of my self.
I am of the view that an effective medical practitioner should be true to himself. I prefer not to play-act a professional role. My view is that being true to oneself is important to healing. Others agree with me: Psychiatric Bulletin, August 2014: “Openness, transparency and candour”
Reflecting today, many months on from my interview, I am wondering if my experience presents another example of a cultural shift in the “professional” use of language?
At my interview I may not have been attune to the current language of healthcare. Equally possible, perhaps it was the interview panel that struggled to attune to my language that has developed in my wider reading of science, in medical humanities and in the arts.
Whatever may be the case, I am of the view that we must be careful in categorising language as “pathological”. This is because what may be determined to be “pathological” may not be the same for all people. I have come to appreciate that the cultures of Arts and Sciences, for example, may approach our use of language quite differently.
Death divided friends
This is Chapter Fifteen of ‘This is Not yesterday’
Death divided friends – The Wilkies of Errol
At 43 Lady Menzies Place, near to the volcanic crags of Edinburgh’s Old Town, Esther Ann Wilkie was born. She arrived into this world at 8.20pm on the last Thursday of September 1870. Esther was my father’s Granny.
Esther was born into a large family and had a balance of siblings: five brothers and five sisters. Her parents, James Wilkie and Ann McIntosh, both hailed from the banks of the Tay, in the hamlet of Errol, just east of Perth.
All of Esther’s older brothers and sisters were born in Perth; in-fact Esther was the first of the family to be born in Edinburgh just after the family flitted there in 1869. Esther’s father, James Wilkie (1828-1893), worked for the Caledonian Railway where he served as a passenger inspector. It may be that James moved to Edinburgh to improve his job prospects with the Caledonian Railway. However the tragic Wilkie family was to suffer deeply from endemic illness which may offer more morbid reasons for their relocation from Perth to Edinburgh.
Figure 1: Esther Wilkie pushing her grandson Stuart (my father) in the pram
The story of Esther’s elder siblings is dreadfully heartbreaking. They were to be victims of tuberculosis at a time when there was no effective cure.
Little John Alexander, aged just three years, was the first to succumb, dying on Christmas Eve 1871. Just three years later Robert Mackintosh, the second oldest child, died of pulmonary tuberculosis. He had just celebrated his eighteenth Birthday, and his father was called for a second time to register the death of a child.
Esther was nine years old when her beloved sister Susan Ann lost her life. Like Robert her lungs had been ravaged by tuberculosis, and as if in a dreadful sororal mirror she had also just turned eighteen. A photograph of Susan survives, taken just before her death. In it she appears pale, graceful and vulnerable. The sadness tells through the words of her sister Esther who had written on the back of the photograph….”Susan the lady of the family”.
Figure 2: Susan Wilkie died a few weeks after this photograph aged 18 years
James, who was the eldest child, and worked as a telegraph Clerk in Edinburgh, died in early August 1885. He had endured a seven month battle against the rigours of the deadly disease. He was nursed by his parents and wife. His insurance policy, honoured on his death, was to be entirely consumed by the debts for medical & nursing care, and by the cost of transporting his body by train to Errol, for internment in the family grave.
Figure 3: James Wilkie died August 1885 aged 29 years
The poor Wilkies they did not have to seek their troubles. Further heartache came with the death of Agnes in 1894, just two years short of her thirtieth birthday. Esther (my father’s Granny) had been very close to her sister Agnes, especially as there only being a couple of years of age between them, and she was devastated by her death. Agnes had also battled in wheezing, breathless gasps, pulmonary tuberculosis. When Esther was later to marry and have children, she was to name her first child after her dear sister Agnes.
Tuberculosis, before science brought cure, had no mercy and most unspeakably it had not finished with Esther’s siblings. David Ritchie Wilkie succumbed to the bacterium in April 1893 he was 21 years of age. Not much more than a year before he himself had lost his infant son to this Nebuchadnezzar.
Figure 4: The Wilkie tombstone greets you to the churchyard
At the entrance to Errol churchyard, and the first to greet the visitor, is the tombstone to the Wilkie family. I have visited myself many decades after any family. I laid flowers for this my forgotten family and in the name of science. With my interest in the medical humanities sometimes others have seemed confused as to what matters to me. I have no such confusion. As an atheist it is written for me on the Wilkie tombstone: ‘death divided friends.’
Awoken
This is the transcript of a short film I made in late May 2011 called ‘AWOKEN’:
I had previously made a film called ‘WAKE-UP CALL’ which was based on the letters of response to this article: Wake-up call for British Psychiatry’ written by 38 Professors in British Psychiatry in 2008: http://bjp.rcpsych.org/content/193/1/6.full
The letters of response were so abundant and so varied that my original film was over 21 minutes long. Some of those who have watched it, despite the length, tell me that they found it far more interesting than this abbreviated version:
AWOKEN
“In this short film, impossibly short for such a subject as mental suffering, I am going to offer you my own awakenings; awakenings that in fact go back many years before the July 2008 alarm call, claxon loud, made by 38 Professors in British Psychiatry.
In my last film, which covered the wide-ranging response to that wake-up call, I tried to present ontological reasoning in the background. However this was a mistake, as layering of personal narrative upon census view, at the same time as revealing wider academic endeavour was simply overwhelming.
At outset let me say that I thought the Wake-up call was a crudely written and narrowly based consideration. The wake-up academics certainly made some points that I agreed with, but others sat uncomfortably alongside patient experience, my journey of knowledge and the oath that I took: (above all) first do no harm. The wake-up call had for me the bedside manner of its much discussed sister paper, ‘What is the Core expertise of the psychiatrist.’
In giving you my views, I want you to know that I feel most uncomfortable. It is a scary task to challenge the collected wisdom of the 38 academics. As for the thoughts I have to make, it was only last week that Alec Salmond, Scotland’s First Minister reminded the reconvening parliament that nobody ‘has monopoly on wisdom.’ I give to you what follows only in that light.
In the next two minutes I shall offer ten summary thoughts regarding the 2008 wake-up to mental suffering and the variety of responses it generated:
ONE: Narrowness of vision. This can be said with certainty, as Professor Craddock takes every opportunity to discount philosophical breadth.
TWO: The Polymathematical. I am sorry, but in my strict terms, Femi Oyebode apart, the wake-up academics are not polymaths. Sadly, within psychiatry there are very few examples.
THREE: The ‘stand-alone’ brain in understanding. Here I ask you only to consider the proportionality of research effort. It seems to me that far too often this marginalises the reality of our social and cultural world.
FOUR: Consciousness. Every time I mention this, my colleagues groan. This perhaps tells us why it is universally ignored by the science of understanding. Research may be difficult, but human consciousness is surely not that of a rat.
FIVE: The objective-subjective divide. Here I appreciate the discomfort of Craddock. Just as he feels ‘caricatured’ as biological-reductionist, I feel reduced as offering nothing more than ‘subjective.’ In the 21st century is it not time to debate the usefulness of this terminology, as so suggested many years ago by Dr Allan Beveridge.
SIX: Disorder. Psychiatrists have no monopoly over the definition of ‘disorder.’ Here we all struggle. However imperfect we need classification but we must not attack one another if we disagree over dimensions. Rather we should debate.
SEVEN: History. Professor Craddock has repeated over and over that he is not interested in the past, and his view, it appears to me, is the prevailing one in our profession wide. The College has embraced the modern, multi-media techniques with its CME modules and podcasts, however look at the content. There is no history, except that of ancient lunacy laws. Where are the considerations of the changing classifications of mental illness, the social and cultural context of mental illness, the language of science and indeed any ideological considerations beyond the medical model. Holism, reductionism, ethics, philosophy, narrative medicine. They just are not there.
EIGHT: The overselling of neuro-scientific explanations. By this I repeat I am atheist, deplore mysticism, and share Professor Craddock’s wish for pragmatism. Science must not over-reach conclusion, for then it becomes scientism and we end up misleading ourselves. If you want examples send a postcard and I will send you a directory.
NINE: Humanities have capitulated to biology. Here I talk of the devolvement of our cultural and sociological worlds. These worlds are as real as the physical energies that invisibly govern so much of today’s technology and communication.
TEN: Reductionism. I deliberately conclude with this. Wholesale attack on reductionism is bad medicine. The remedy does not lie in abandoning reductionism where it is appropriate, but like Evidence-based medicine, we must recognise where it is necessary, but not sufficient. Let us accept that numbers (that which is quantifiable) and words (the qualitative) should be understood as equal forms of measurement. My life stands by this.
